The Elusive Electronic Health Record

My dad (Stan Feld) has been talking about the electronic medical record for as long as I can remember (probably 30+ years.) As a kid, some of my early computer projects were trying to write a program that had some semblance of addressing this – well before I had any grounding in (or understanding of) databases, user-centric data entry (um – the “web” anyone?), or distributed data (um – the “Internet” anyone?)

When I finally learned what a relational database was (about 24 years ago – Btrieve was the first database that I mastered – yes – I’m old enough to have started with an ISAM instead of an RDBMS.) I got excited about the idea of building an electronic medical record. I’m sure part of this was to please my dad – but part of it was because it seemed like such an obviously useful thing.

Over the last 24 years, I’ve watched numerous people and companies fail miserably at this. In my first company, we did some consulting to a few larger health care organizations (really “multi-group medical practices and a few hospitals) around this but nothing really emerged, other than a couple of customer patient management systems that really had very little to do with the patient’s medical record.

30 years later Stan is still talking about it. His post yesterday titled Electronic Health Record Part 2 continues a theme he’s been on for most of his career. I’m sure there are plenty of other doctors out there that say something like “I believe a patient should be responsible for his / her medical history”, but I know my dad has been saying this to his patients since the day he started his medical practice. My dad tells you how to solve the Personal Medical Record side of this equation today for $15 but goes much further by detailing the issues around The Complexity of the EMR Issue.

Over the last dozen years, I’ve seen many entrepreneuers and many business plans that proport to create a universal electronic medical record. I still don’t have one and I know there isn’t a ubiquitous approach for this. You’d think that with all the money that’s spent (and wasted) in our health care system, we’d be closer to a solution.

My doctor’s office, which is part of a large Wisconsin chain, converted to all computerized records last year. I think it’s a local network with clients, not web-based.

Flatscreens in each office. Everything is typed in to the computer. Old records are stored via PDF scans. All the prescriptions are typed and printed in the evaluation rooms.

My doctor thinks it’s awesome but admits the older doctors are not fans.

I believe the entire system is via a local Wisconsin entrepreneur.

http://www.tkeller.com Tom

In thinking about about entrepreneurially oppportunities, an often prescribed approach is “look for pain/inconvenience, and figure out how to solve it.”

I cannot go through with this exercise without always ending up at universal medical records. It’s a huge pain (ignore the pun) for a huge segment of the population. I’ve personally experienced it; almost all patients have. Insurance companies experience it. Caregivers suffer from it.

Yet, despite efforts, nobody has figured it out. I’m sure there is a huge pot of gold for whoever does.

http://www.feld.com Brad Feld

Can you get your entire record from your doctor? That’d be a decent next step. I bet you have more than one doctor (I do – especially when I’m at my place in Alaska and something goofy happens to me – like I get poisoned by something and have to go to the hospital for a blood test) – it’d be great if they could “integrate” (vs. getting a faxed lab result which they then have to scan in.)

It’s all progress, but SLOW. I remember talking to my dad about computers in exam rooms in the 1980s. I think he may have even had some old IBM PCs networked together and tossed in the corner of some of his exam rooms. The green bulky monitors would have fit right in with everything else.

http://www.blackmailr.com/smr Whitney McNamara

There’s been a push recently from the employer side, as well. Under the umbrella of the Dossia project (google fodder), five big employers “announced an initiative to provide their combined 2.5 million employees and their dependents with personal health records in an effort to reduce administrative costs, duplicative care and medical errors.” It’s big-ticket folks:

Applied Materials

BP America

Intel

Pitney Bowes

Wal-Mart

I have a good friend who works for the Omnimedix Institute, which is the nonprofit tasked with creating the personal health record (PHR) infrastructure for these guys, so the undertaking came immediately to mind.

Paul – if history is a guide, that is precisely why EMR investments make sense. I’d never rely on the heavyweights to get it right at this point.

http://https://www.revolutionhealth.com/blogs/valjonesmd Val Jones

I’m a big fan of your dad, by the way. I quote his blog frequently in my own. This is a beast of a project (a successful national EMR is like building the Transcontinental Railroad)… but we have to keep chipping away at this. At Revolution Health we’ve gotten to step 1 (a “fax your records” program where if consumers can get their mits on their paper records we can digitize them and keep them in one place for future reference). There are 1000 more steps… We need to form a coalition!

http://www.feld.com Brad Feld

Val – nice to hear from you. My dad has been keeping me posted on what y’all are doing at Revolution Health – cool stuff!

http://www.brmaier.com Brad Maier

I don’t claim to be particularly knowledgeable in the field but I have kicked this idea around with some friends who work in the insurance industry and I’m wondering if it has been brought up or if it has made any ground. So much information can be put on a card, why not put your medical record as a scanable feature on a drivers license or your insurance card or create a system that acts like a medical atm, put the card in and access your medical record from anywhere. It protects privacy of information and consent because you need the interaction of the card which is held by the person. Heck, if privacy is a huge issue then pin protect it like atm cards. It also seems to alleviate the problem of system compatibility. On the off chance that anyone thinks this is a fantastic business opportunity feel free to contact me haha.

http://www.wellingtonfund.com/blog/ MRM

There is hope. Our firm announced today a $15.5MM venture debt financing in the space for the acquisition of VantageMed, a provider of practice management software.

Regarding interoperability, one interesting place to check out is http://www.chartbiopsy.com; they have an EMR system that’s designed specifically to allow different offices to communicate. It was originally designed primarily for local free clinics that end up sharing a lot of patients. (I know about them both through volunteer work at these clinics and they asked me for feedback occasionally on the interface.) Anyhow, recently they’ve announced they’re going to start offering office accounts to regular medical practices.

I’m just a resident so I haven’t been exposed to a huge number of systems, but I do think this one is pretty easy to use; also its dirt cheap at $29/month. The downside is that it’s web-based, so if your connection is slow/unreliable it probably won’t work…

http://www.worldmedcard.com DP

I agree, with your Dad !! Empowered patients are healthier people. Have found that tracking patient records for mother

Steve

MRM: demands for single db Emr-ppms are high in the practice. also, there is high failure in terms of current tier 1 solutions templating, free text code capture is impossible, and eRX remains impossible because pharmacies are correctly connected yet, among many other pain points. Not sure i see the positive of your “due dili” on vantage med, but always wish you best.

Integration is really interfacing. Companies, even the likes of GE HC, are providing interfaces to their equipment, if, for example, you decide to run a different product – i.e. CVIS from best of breed. In relation to physician practice – tier 1 and really all CCHIT products offer strong unidirectional interface to labs. Higher level image inbound/outbound to labs and ancillary centers also possible, and true for other interfaces. Of course, you will have to pay.

The real answer, from my perch of course, lies in the data the claims folks have. A combination of hospital CDR plus claims data will give quite an incredibly full picture – or that universal touch. However, maybe the idea is working out these partnerships – say start with big IDN and big claims. Another approach is the smartcard – a la Siemens and their recent use of for local East Coast RHIO activity (really i would consider this akin to NPI, which many be dead in the water from govt perspective – so scoots the issue in a nice way). As far as PHR – medem is rubbish. totally rubbish. The PHR offered in coordiation with care treatment and other activities is better. medem misses the idea of a great PHR – rounded information, trending/historical analysis, integration. PHR is dead money as well at this moment. However, places have begun to combine solid patient/physician communication platforms with PHRs, and have seen some real nice outcomes – think relay health here as well. Last i checked a Dartmouth program was moving this way.

Universal Health Record will be piecemealed unless you can establish the iron clad enemies of data mongering. Provide a backwards incentive, and you may somehow open this nut – sort of like iTunes to the consumer and benefits industry. i have some ideas, but not worth too much getting into.

some other great areas for vc investment, or private equity, off the cuff, would be
1)ICU – terribly inefficient, monitoring/IT needs
2)POC – point of care. So many technologies, and a revitalized lwapp style network is allowing POC to really be an opportunity. think context-aware and passive RFID, as a start, and not just the often heard “RFID” and others
3) Cardiovascular IS – right now data dump templates. live dashboards, kpi’s, information style driven content on live update comes to mind. 4) enterprise visibility. need i say more. incredible area
5) closed loop med mngmt. another great place, especially for app developers. so many pieces, so archaic.
6) believe it or not: middleware – still widely needed, done badly by big companies, and minimal players in top level competition
7)smaller, portable flexible wireless monitoring
8)voip medical grade phones/communication devices. current ones are a joke. yes, that includes you cisco.
9) surgery automation – from peri to surg to post op
10) crowded but needs innovation – bar coding devices driven by system integration (items like iv pumps etc). the current stuff is piecemeal.

there are others, but this is IT perspective. hope this helps and didn’t rattle on for nots.